Alex Angueira/Solomon ZalmanMIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term spedfically includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (First)
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BUSINESS NAME AND ADDRESS (Num~ber and Street) (C~) - (Stat~)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
(M.I)
(Zip Code)
I. LOBBYIST RETAINED BY:
b
NAME OF PRINCIPJ~i~_/'CLIENT: '-
BUSINESS NAME AND ADDRESS
3 c)~-s~-Itt'/
TELEPHONE NUMBER:
(Number and Street) (City) ,_tla__, (Zip Code)
FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
prom r~ ord; r~n ~ c~r, rd; n
q
Issue'to be lobbied (Describe in detail~ d
III. ClTY AGENCIES/INDI¥~DUALS TO BE LOBBIED:
A) Full Name of Individual/TiUe
B) Any Financial, Familial or Professional Relationship
IV. DI'SCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSA'rZON (DLSCU~E WHETHER HOURL~
FL4T RATE OR OTHER):.
A) LOBBYIST DISCLOSURE: (Required) ~~'~ ~~ ~/O~) t 0~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ ~ ~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
[] Yes ~No: Are you Iobbyinq on a present or pendin,q bid for goods, equipment or services~ or on ~' / ! oresent or pendinq award for needs, eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development :Issues":
E]Yes,~o: Are you Iobbyinq on a pendinq application for a Development Aqreement with the City or
aoolication for change of zoning map desiqnation or change to the City's Future Land Us,=,
,Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
D Yes ~0: Are you representing a not-for-profit corporation or entity without Special compensation
! ~ or reimbursement..
V. STGNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CTrY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.~rAT~'NT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE~ OR COMPEflSAI'g0N DURING THE
REPORTING PERIOD.
Signature o-'l"[obbyist
! do solemnly swear that all of the foregoing facts are' true and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Principal/Clien/
VI. LOBBYIST TDENTTFICATZON: PRZNCTPAL TDENTZFZCATZON:
Form of :identification Form of :identification
[] Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
[] Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn a?~, subscribed before me
This / ~ ;~' day of ~C~,~_ r_~l~ ~ald Ja~ Ki~ Jr ~i~ ~ day of ~~~O~ ~ j~ Ki~a~ Jr
Signature of P~ota~ - S~te of Florida Signature of Public No~te ~rid~
No~rizaUon of Lobbyi~s signature No~rizaUon of Principal's signature
~,~/ FOR CLERK'Su~, ~'"'~ ,USEo'ONLY
Registration fee: [ Yes [ ] No Amoun]; P~a ~ NCR/~'~ / Date Pai
Annual
Lobbyist Registration Form received and vedfied by: ~}'.~' ~' -
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05~x:/~_,,~ Revised 12/08/04